Middleburg Borough 13 North Main Street Middleburg, PA 17842  570-837-2533  Complaint Form  Resident of Middleburg!  Employeel  Name: Address: City/State: Phone# #:  Date of Report Complaint Against:  Date of Incident / Occurrence: Time of Incident / Occurrence: Location of Incident/Ocourence:  Nature of Complaint: (Cover: who, what, when, where, why)  How Received: Letter Received Fax How Handled: Letter Sent  Phone Visit  Fax Sent Phone In Person Refer to Other Agency  *NOTICE*  Under Section 4904 oft the PA Crimes Code, unsworn falsification to authorities; a person commits a misdemeanor oft the third degree ifhe/she  makes av writtens statement which! he/she does not believe to be true.  Received Date: Received By:  Complaining Party  Form: Borough Complaint 2018